1. MINDFULNESS-BASED COGNITIVE THERAPY for CANCER (MBCT-Ca)
Gently Turning Towards
Trish Bartley and Ursula Bates

2. The Three Circles Model

3. The Circle of Suffering

4. Distress in oncology patients

5. Avoidance
Avoidance coping strategies include behavioral or cognitive efforts to keep oneself from thinking about a stressful problem or situation. Avoidant coping strategies can also be associated with withdrawal from valued social support resources, particularly following traumatization

6. Rumination
Rumination is a way of responding to distress that involves repetitively (and passively) focusing on the symptoms of distress, and on its possible causes and consequences. Rumination is more common in people who are pessimistic, and who have negative attributional styles. The tendency to ruminate is a stable constant over time and serves as a significant risk factor for clinical depression. Not only are habitual ruminators more likely to become depressed, but experimental studies have demonstrated that people who are induced to ruminate experience greater depressed mood. There is also evidence that rumination is linked to general anxiety, post traumatic stress, binge drinking, eating disorders, and self-injurious behavior.

7. Trauma
Some survivors of cancer experience trauma -related symptoms similar to symptoms experienced by people who have survived highly stressful situations, such as military combat, natural disasters, violent personal attack, or other life-threatening events. This group of symptoms is called post-traumatic stress disorder (PTSD) and includes avoiding situations related to the trauma, continuously thinking of the trauma, and being overexcited.
People with histories of cancer are considered to be at risk for PTSD. The physical and mental shock of having a life-threatening disease, of receiving treatment for cancer, and living with repeated threats to one's body and life are traumatic experiences for many cancer patients.

8. Distress in Cancer Patients
It is estimated that 10% - 50% palliative care patients have significant anxiety and depression, 35% have unmet emotional needs and % have inadequate pain relief
(Bradley, Fried, Kasl, & Idles, 2000).
The variation in rates depends on the stage of the illness, level of disability and degree of pain. These needs. include many co morbid mental health disorders which are often undetected, complex bereavements and end of life issues (NCHSPCS 2000).

9. A Cognitive Model of Cancer Distress
Moorey, S & Greer, S, (2002) , Cognitive behaviour therapy for people with cancer . Oxford: OUP.

10. The Circle of Practice

11. The Middle Ring - Four Movements
Intention Coming Back Turning Towards Kindness

12. The Circle of Presence

13. The Middle Ring - Four Qualities
Appreciating the Richness of Experience
Experiencing the Ground of Clarity
Confidence to be with Experience
Connecting to our Common Humanity

14. The Three Circles Model

15. Going Across the Circles
Trauma >Intention >Appreciating the Richness of Experience
Rumination >Coming Back >Experiencing the Ground of Clarity
Avoidance> Turning Towards> Confidence to be with Experience
Distress> Kindness> Connecting to our Common Humanity

16. Resources and References
Shennan, C., Payne, S., Fenlon, D., (2010).What is the evidence for the use of mindfulness-based interventions in cancer care? A review. Psycho-Oncology DOI: /pon.1819
Bartley, T., (in press), Mindfulness-Based Cognitive Therapy for Cancer: Gently Turning Towards. Oxford: Wiley Blackwell
Speca, M., Carlson, L.E., Goodey, E., & Angen, M., (2000) A randomised, wait- list controlled clinical trial: The effect of a mindfulness meditation-based stress reduction program on mood and symptoms of stress in cancer outpatients. Psychosomatic Medicine, 62,
CMRP 2 day retreat workshop on 2-4th November 2011 in North Wales. ‘Mindfulness Based Cancer Therapy for Cancer’ led by Trish Bartley